Provider Demographics
NPI:1902531379
Name:TISHMAN, OLIVIA (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:TISHMAN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 DARCEE CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-7402
Mailing Address - Country:US
Mailing Address - Phone:678-858-4777
Mailing Address - Fax:678-985-3953
Practice Address - Street 1:1509 ATKINSON RD STE 2200
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-7986
Practice Address - Country:US
Practice Address - Phone:678-858-4777
Practice Address - Fax:678-985-3953
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist